Workforce Shortage Shutting Down Hospice Programs

Worsening workforce shortages have been keeping hospice leaders awake at night for several years running. Rising turnover due to the COVID-19 pandemic has exacerbated the crisis, and some hospice providers and health systems are starting to shut down their programs or sell off their operations because they cannot recruit or retain a sufficient number of employees.

A recent casualty is the Idaho-based Minidoka Memorial Hospital home health and hospice program. The hospital announced this week that it will shutter those operations on Sept. 20 due to insufficient staffing.

“We’ve had positions posted for two years and have had exactly zero applicants,” Minidoka Memorial Hospital CEO Tom Murphy told local newspaper the Times-News. “The harsh reality is that we don’t want to run a service that we can’t operate to the best of our ability.”

Four other hospice providers serve patients in the Minidoka service region.

Health care providers have seen staff turnover rise during the pandemic, and hospice is no exception. Slightly more than 20% of health care workers have considered leaving the field due to stress brought on by the pandemic, and 30% have considered reducing their hours, according to a recent study published in JAMA Network Open.

But the shortage did not begin with the outbreak, it has been building for years as hospice employees age with the rest of the population and seek retirement. About 10,000 people in the United States reach the retirement age of 65 every day, according to the Kaiser Family Foundation.

Hospices face unique recruitment challenges, particularly because medical, nursing, and social work students receive very little exposure to hospice or palliative care during their training. A 2018 study concluded that most students in clinical disciplines do not feel prepared to provide family care at the end of life.

Few hospice providers have been able to dodge the staffing bullet, but most are carrying on. That is not the case for some. Like Minidoka, the Oregon-based Grande Ronde Hospital and Clinics recently closed its hospice program due to staffing shortages. The organization indicated that the COVID-19 pandemic exacerbated industry-wide workforce issues, leading to the decision to close.

“Our community is not exempt from the serious national shortage of health care workers. Over the past year, it has become increasingly difficult to find nursing staff to support our hospice program,” said Grand Ronde President and CEO Jeremy Davis.”

Independent hospice providers that are not affiliated with a health system are also feeling the pain. The Dare County Board of Commissioners in North Carolina recently approved the sale of its local home health and hospice agency to BrightSpring Health Services for $2.9 million. The deal is contingent upon BrightSpring maintaining services throughout the Dare County agency’s current service region and retaining its employees.

Louisville, Ky.-based BrightSpring is a portfolio company of the global investment and private equity firm KKR & Co., which purchased the company in 2018 for approximately $1.32 billion.

The county began a bidding process late last year after determining that operating the agency themselves was no longer financially sustainable. They also cited a lack of sufficient staff to meet growing demand for hospice in their region, County Manager Robert Outten told Hospice News. The county board approved the sale agreement in a six-to-zero vote.

“We have a difficult time getting qualified staff, and the need for hospice care has grown as well,” Outten said. “To sustain it would require a big injection of money to change salaries, and even then we have no assurances that we can get the staff that we need. Our patient counts are declining because we didn’t have enough staff.”